When acute myocardial infarction (MI) occurs in patients with systemic hypertension, the systemic arterial and left ventricular (LV) pressure generally returns to or toward normal if the MI was fairly larte. When acute MI occurs in patients with significant aortic valve stenosis (AS), however, the LV systolic pressure remains elevated and the continuation of this pressure elevation increases the likelihood of LV rupture or aneurysmal formation, particularly when the MI involves the LV apical wall which normally is several times thinner than the LV basal wall. Such was the case in a 67-year-old man, who died of progressive congestive heart failure after healing of more than 1 (by history) acute MI in the previous 5 years. At necropsy, he had a severely stenotic congenitally bicuspid aortic valve and a large apical aneurysm at the site of a healed LV MI.